Provider Demographics
NPI:1265525950
Name:PRESCRIPTION SHOP
Entity type:Organization
Organization Name:PRESCRIPTION SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MILLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-583-9652
Mailing Address - Street 1:143 CRAIG STREET
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119
Mailing Address - Country:US
Mailing Address - Phone:830-583-9652
Mailing Address - Fax:830-583-3923
Practice Address - Street 1:143 CRAIG STREET
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119
Practice Address - Country:US
Practice Address - Phone:830-583-9652
Practice Address - Fax:830-583-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04530332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141618Medicaid
TX141618Medicaid
1187300001Medicare ID - Type Unspecified